PB2356: OUTCOMES OF PATIENTS WITH PRIMARY CNS LYMPHOMA (PCNSL) WHO UNDERWENT TREATMENT WITH DEANGELIS, MATRIX, AND PRIMAIN PROTOCOL.: A RETROSPECTIVE SINGLE-CENTER STUDY
Authors: Michelle Richardson, Satish Rayadurgam, Victor Ling, Sheraz Bashir, Seoksan Teh, Deborah Abrams, Zafar Ullah, Nicola Gill, Andrew Hodson, Mahesh Prahladan
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Primary central nervous system lymphoma (PCNSL) is a rare and aggressive subtype of non-Hodgkin lymphoma that arises in the brain, spinal cord, and/or eyes. Despite advances in treatment, PCNSL remains challenging to manage, and its prognosis is poor in patients with advanced age and significant comorbidity. This retrospective study aimed to evaluate the clinical outcomes of patients with PCNSL treated with DeAngelis (MTX, intrathecal MTX, vincristine, procarbazine, dexamethasone, high-dose cytarabine, and whole brain radiotherapy), MATRix (HD-MTX, Ara-C, Thiotepa, Rituximab), or PRIMAIN (Rituximab, HD-MTX, Procarbazine) protocols and to determine the impact of age and treatment on overall survival (OS) and progression-free survival (PFS). Aims: The aim of this study was to evaluate the impact of age and treatment protocols on OS and PFS in patients with PCNSL. Methods: We retrospectively analyzed the medical records of 15 patients with PCNSL who received treatment at our single center over the past 10 years. The patients were divided into three groups based on the treatment protocol they received: DeAngelis, MATRix, or PRIMAIN protocols. We calculated OS and PFS for each patient and performed statistical analyses to determine the impact of age and treatment on these outcomes. Results: Our analysis showed that the MATRix protocol resulted in the highest Overall survival (OS) and Progression free survival (PFS) rates, compared to DeAngelis and RMP. Of the 15 patients, 10 were treated with MATRix, 3 with DeAngelis, and 2 with RMP. The median OS was 26.2 months and the median PFS was 16.3 months. MATRix protocol resulted in a longer median OS (30.4 months) and PFS (22.5 months) compared to DeAngelis (20.7 months and 13.2 months, respectively) and RMP (11.5 months and 5.6 months, respectively). Patients younger than 70 years had a significantly higher OS and PFS compared to older patients. The median age at presentation for the 15 PCNSL patients was 65 years (range 42-78). The median progression-free survival (PFS) for the entire cohort was 14 months (range 0-57 months). In terms of treatment complications, thrombocytopenia was the most common, followed by neutropenia and mucositis. We also found that hospital admission due to sepsis was associated with a poorer OS. Summary/Conclusion: Our study highlights the importance of age and treatment selection in the management of PCNSL. The MATRix protocol demonstrated better clinical outcomes compared to DeAngelis and RMP. Compounding factors including age, perfromanace status and associated co-morbidities also influenced the outcome. Early diagnosis and aggressive management of treatment complications may help to improve OS and PFS in PCNSL patients. Further studies are warranted to confirm these findings and optimize treatment strategies for this challenging disease. Keywords: CNS lymphoma, High dose methotrexate, Outcome measurement, Clinical outcome